Estenosis Traqueales en Resumen

Tracheal stenosis is defined as narrowing of the airway from the level of the cricoid, including the trachea and sometimes the main bronchi.

Congenital tracheal stenosis in neonates with severe stenosis causing respiratory symptoms should prompt evaluation for associated congenital cardiac anomalies.

Acquired tracheal stenosis typically occurs in older children or adolescents who were previously intubated.

Patients who develop stenosis post-intubation generally had a severe underlying illness requiring prolonged intubation, such as sepsis or multiple organ failure.

The area below the cricoid is the narrowest point and most susceptible to injury during ventilation, making it the most frequent site of stenosis.

In acquired stenosis, symptoms typically appear 15 days after extubation.

Medical management for acquired stenosis includes anti-reflux therapy and treatment of tracheomalacia.

Congenital tracheal stenosis is often associated with cardiac anomalies and may involve complete tracheal rings requiring slide tracheoplasty or bypass procedures.

CT with 3D reconstruction is used to evaluate the percentage of stenosis and the length of the affected segment.

The second surgical principle is that resection-anastomosis without tracheoplasty is preferred when feasible; tracheoplasty is reserved for stenosis involving more than half the trachea.

Interrupted absorbable sutures are used for anastomosis, with the key consideration being adequate vascularity and tissue viability of the distal segment.

Two strong lateral sutures are placed as anchoring points, with additional interrupted sutures placed anteriorly depending on tension.

Monofilament sutures (such as Prolene) may be preferred in some cases to minimize inflammatory reaction, though this involves trade-offs.

When cutting the trachea for resection, cutting at an angle (half upward, half downward) reduces tension on the anastomosis by allowing the rings to support each other.

Postoperative endoscopy is typically performed between day 6 and day 21, with day 6 being the earliest recommended time.

Early endoscopy (before day 6) is discouraged because the anastomosis site is edematous and direct contact with the endoscope can cause injury.

Clinically, restenosis presents with progressive respiratory symptoms rather than acute deterioration.

In one case of restenosis, endoscopic examination revealed fibrin and suture material that could be manipulated to release scar tissue, avoiding the need for tracheostomy.